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Research Questions

What questions should the CCBHC demonstration evaluation study address?

What data sources exist to answer the evaluation research questions?

How should comparison groups for the evaluation be selected?

How should the evaluation be designed?

This report provides information and recommendations regarding the evaluation design of the Certified Community Behavioral Health Clinic (CCBHC) demonstration. Mandated by Congress in Section 223 of the Protecting Access to Medicare Act of 2014, the CCBHC is a new model of specialty behavioral health clinic, designed to provide comprehensive and integrated care for adults with mental health or substance-use disorders and children with serious emotional distress. Certification criteria for the CCBHCs have been specified by Substance Abuse and Mental Health Services Administration covering six core areas: staffing; accessibility; care coordination; scope of services; quality and other reporting; and organizational authority, governance, and accreditation. In addition, services provided to Medicaid enrollees in CCBHCs will be reimbursed through one of two alternative prospective payment systems. At present, 24 states have been awarded grants to begin the planning process for implementing CCBHCs. Of these states, eight will be selected to participate in the demonstration project beginning in January 2017. Results from the evaluation will inform mandated reports to Congress over the two-year demonstration period and the three years following the end of the demonstration, providing information to policymakers on the program's impact and value. In addition, the results can inform the direction of future efforts at integration of behavioral health into the health care system at this critical time of transformation.

Key Findings

Enormous variability exists across states in the availability of data that could potentially inform the CCBHC evaluation, including variability in Medicaid claims data, other human services utilization data, and health and social functioning outcomes data.

The CCBHCs are being implemented at a time when multiple service delivery innovations that target the same or overlapping patient populations are being tested. This context should be taken into account in the design of the evaluation.

Implementation questions may be addressed through a combination of existing data sources, including documentation of compliance with certification criteria, required quality measure reporting from the CCBHCs and the states, and cost reports. Supplemental data sources, such as quarterly reports from CCBHCs, surveys of providers, or qualitative studies of selected CCBHCs may also prove valuable.

Impact questions can be addressed through data from Medicaid claims or encounters covered by managed care payments. Detailed analytic plans, including selection of comparison groups, will need to be informed by conditions within demonstration states regarding the delivery system and data availability.

Recommendations

We recommend that the evaluation of the CCBHC demonstration project have three components. First, the evaluation should compile profiles of the mental health systems in each of the demonstration states. Second, the implementation questions can be addressed through a mix of existing data sources and supplemental data collection efforts. Third, the impact questions can be addressed primarily through analysis of the claims and encounter data, with additional information drawn from cost reports or, potentially, other state specific data sets.

The evaluation of the CCBHC demonstration can be efficient by making maximum use of existing data to reduce costs in describing the implementation of the model and its impact on care. The ultimate evaluation design will depend on the data sources available in the eight states selected for the demonstration and the resources available for the evaluation.

The evaluation has the potential to impact policies in the behavioral health arena in a fundamental way, providing guidance on the value of strengthening and growing the traditional model of CMHCs through expansion of their scope and reform of their financial structure.

Table of Contents

Chapter One

Introduction

Chapter Two

Evaluation Research Questions

Chapter Three

Data Sources

Chapter Four

Comparison Groups

Chapter Five

Design Recommendations

Appendix A

Planning Grant Awardees

Appendix B

Required Quality Measures

Appendix C

Methods for Evaluation Design

Appendix D

Discussion Questions

Appendix E

Example of Data Flow

Appendix F

Estimated Burden of Data Collection

The research described in this report was sponsored by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and conducted by RAND Health.

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